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EDGEWOOD SPRING CREEK MERIDIAN, LLC
NPI 1891078705
Assisted Living Facility in Meridian, ID

Active since September 27, 2011CLIA 13D2195031 · Waiver
175 E CALDERWOOD DR, MERIDIAN, ID 83642(208) 884-6199 Get Directions Write a Review

NPPES record last updated: August 19, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Edgewood Spring Creek Meridian, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDGEWOOD SPRING CREEK MERIDIAN, LLC (NPI 1891078705) is a healthcare organization registered as an assisted living facility in Meridian, Idaho and active in the NPI registry since September 2011. The organization holds a CLIA Waiver certificate valid through October 5, 2026 and lists John Dybwad, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1891078705
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD SPRING CREEK MERIDIAN, LLC
Location Address175 E CALDERWOOD DRMeridian, ID 83642-7482
Mailing AddressPo Box 13238Grand Forks, ND 58208 · (701) 738-2000
Phone(208) 884-6199
Organization SubpartNo
Authorized OfficialJohn DybwadVp Of Finance · (701) 757-5422
Enumeration DateSeptember 27, 2011
Last NPPES UpdateAugust 19, 2022
NPPES CertifiedAugust 19, 2022
✔ NPI 1891078705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in ID · RC1008
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
175 E CALDERWOOD DR, Meridian, ID 83642
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2195031

Edgewood Spring Creek Meridian LLC · Meridian, ID
Active · expires Oct 5, 2026
CLIA Number13D2195031
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 6, 2024
Certificate Expiration DateOctober 5, 2026
Laboratory DirectorKarla Vaughn
Laboratory Phone(208) 884-6199
Laboratory LocationEdgewood Spring Creek Meridian LLC175 E Calderwood Dr, Meridian, ID 83642
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SPRING CREEK IDAHO, LLC
Assisted Living Facility
175 E CALDERWOOD DR
MERIDIAN, ID 83642
Ada County (208) 884-6199

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edgewood Spring Creek Meridian, LLC's NPI number?

The NPI number for Edgewood Spring Creek Meridian, LLC is 1891078705. It was assigned to this organization in the NPPES registry on September 27, 2011.

Where is Edgewood Spring Creek Meridian, LLC located?

Edgewood Spring Creek Meridian, LLC is located at 175 E Calderwood Dr, Meridian, ID 83642. The listed phone number is (208) 884-6199.

What is Edgewood Spring Creek Meridian, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Edgewood Spring Creek Meridian, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2195031) is associated with this NPI, valid through October 5, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Edgewood Spring Creek Meridian, LLC was last updated on August 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.